Assessment of Prognostic Value of Peritoneal Lavage Cytology in Patients with Resectable Gastric Cancer

The gastric cancer generally is considered a geriatric disease, which occurs commonly among lower socioeconomical levels of the populations. There are wide differences in the gastric cancer occurrence among different geographical regions. In Iran, the northern and the northwestern regions are with the most higher risk of gastric cancer occurrences. In spite of the recent gastroscopical examinations, almost of the gastric cancers are diagnosed in the advanced stages. Peritoneal relapse is the most common form of gastric cancer recurrence after the surgery and it is the leading cause of the mortality in the gastric cancers. The peritoneal relapse is formed from the micrometastases originated of free peritoneal tumor cells (FPTCs) in the peritoneal space. It is a bad prognostic aspect for the patients with gastric cancer. The randomized clinical trials suggest that adjuvant intraperitoneal chemoperfusion demonstrated significant median survival difference in comparison with simple surgery group. In this study we tried to compare the prognoses and the time and location of the recurrence of gastric cancer between the patients with negative and positive cytology. Patients who were eligible were those who were deemed fit enough for a general anesthetic and those with potentially resectable and curable disease, i.e. no CT evidence of metastatic disease or unresectable invasion into adjacent structures. Pre-laparoscopic staging in all cases involved upper gastrointestinal endoscopy and biopsy, followed by CT of the chest and abdomen. Staging laparoscopy was performed within six weeks of CT in all cases. For target patients peritoneal lavage and cytological examination were performed. Nineteen of 62 patients who underwent staging laparoscopy and peritoneal lavage cytology had malignant cells within the lavage fluid, i.e. FPTC-positive (30.6%). The median age was 62.27±12.87 years (range 24–89) with a male:female ratio of 2.6:1. Fourteen of these patients (73.7%) subsequently underwent laparotomy for an attempted curative resection. In five out of these 14 patients, incurable disease was found (unresectable local invasion or extensive lymph node, peritoneal and liver metastases) and no procedure or a palliative procedure was performed. There was a significant difference between peritoneal lavage cytology and resectable gastric cancer (p=0.002). Of the 12 patients with positive cytology, seven cases (58.3%) had recurred gastric cancer and the rest five cases (41.7%) had no recurrences. Of the patients with negative cytology, only a single patient had recurred gastric cancer (2.56%). There was a significant relationship between gastric cancer recurrence with positive cytology results (r=0.78; p=0.001). The mean recurrence time in the seven patients who had recurred gastric cancer was 6 months ± 1.41. In two cases with negative cytology, there was recurred gastric cancer after 6 months. There was a significant relationship between gastric cancer recurrence with positive cytology results (r=0.89; p=0.02). Considering above, we may come to the end that there is a significant relationship between positive peritoneal lavage cytology and cancer recurrence, common recurrence location of the tumor and the probability of cancer recurrence. Based on the results of abdominal lavage cytology, the appropriate therapeutic method may be selected for improving the life quality of the patients with gastric cancer.